The maximum reimbursement limit for large outpatient and emergency medical expenses is 20,000 yuan. Only medical expenses above 2,000 yuan can be reimbursed, and the reimbursement ratio is 50%. For retirees under the age of 70, expenses exceeding 1,300 yuan can be reimbursed at a reimbursement rate of 70%. For retirees over 70 years old, the reimbursement rate for expenses exceeding 1,300 yuan is 80%.
Urban employee medical insurance mainly consists of two parts: basic medical insurance and supplementary medical insurance. Since the reimbursement regulations of each city are different, there are no unified regulations on the reimbursement scope of employee medical insurance, but the basic items and scope are similar.
The basic scope includes:
1. Outpatient and emergency medical expenses;
2. The cost of purchasing medicines at designated retail pharmacies;
3. For emergency rescue patients who are kept under observation and admitted to hospital for treatment, the medical expenses for the 7 days of observation before hospitalization;
4. Radiotherapy and chemotherapy for malignant tumors, renal dialysis, and post-kidney transplantation services Outpatient medical costs of antirejection drugs.
However, the following items are not within the reimbursement scope of urban employee medical insurance:
1. Service items: registration fees, out-of-hospital consultation fees, medical record costs, etc.
2. Non-disease treatment items: various beauty and bodybuilding items, as well as non-functional plastic surgery, orthopedic surgery, etc.
3. Diagnostic and treatment equipment and medical materials: such as inspection and treatment projects for large medical equipment.
4. Treatment items: such as functional therapy, music therapy, health nutritional therapy, magnetic therapy and other auxiliary treatment items.
5. Others: diagnosis and treatment items for various infertility (pregnancy) diseases, sexual dysfunction, etc.
Legal basis
"Social Insurance Law of the People's Republic of China"
Article 28
Comply with basic medical insurance Drug catalogs, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance fund in accordance with national regulations.
Article 29
The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit . The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.